Skip to main content
Top
Published in: Obesity Surgery 2/2011

01-02-2011 | Clinical Research

A Survey of Dumping Symptomatology after Gastric Bypass With or Without Lesser Omental Transection

Authors: Constantine T. Frantzides, Mark A. Carlson, Valerie K. Shostrom, Jacob Roberts, George Stavropoulos, George Ayiomamitis, Alexander Frantzides

Published in: Obesity Surgery | Issue 2/2011

Login to get access

Abstract

Background

Lesser omental transection during gastric bypass for morbid obesity may be associated with postoperative dumping. A survey of postoperative symptoms was performed in patients undergoing laparoscopic Roux-en-Y gastric bypass with transection vs. preservation of the lesser omentum.

Methods

A written questionnaire on dumping symptoms was administered to patients 2 years after laparoscopic Roux-en-Y gastric bypass with or without transection of the lesser omentum. Statistical testing was performed to determine whether the rate of various symptoms was related to the transection of the lesser omentum.

Results

The patients without lesser omental transection had significantly less symptoms than the patients with transection for 11 out of the 17 symptoms that were queried (p < 0.05). Ingestion of sweets was associated with dumping symptoms more frequently in the group of transected patients, and this group also had a lower frequency of sweet eating (p < 0.05).

Conclusion

This study demonstrated that transection of the lesser omentum during laparoscopic–gastric bypass was associated with more postoperative dumping symptoms compared to bypass with preservation of the lesser omentum. This association may be secondary to a partial vagotomy that may occur if the lesser omentum is transected during gastric bypass.
Literature
1.
go back to reference Schauer P, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. Berlin: Springer; 2007. p. 237–316. Schauer P, Schirmer BD, Brethauer S. Minimally invasive bariatric surgery. Berlin: Springer; 2007. p. 237–316.
2.
go back to reference Leslie DB, Kellog TA, Ikrammudin S. Laparoscopic Roux-en-Y gastric bypass. In: Soper NJ, Swanstrom LL, Eubanks WS, editors. Mastery of endoscopic and laparoscopic surgery. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 262–71. Leslie DB, Kellog TA, Ikrammudin S. Laparoscopic Roux-en-Y gastric bypass. In: Soper NJ, Swanstrom LL, Eubanks WS, editors. Mastery of endoscopic and laparoscopic surgery. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 262–71.
3.
go back to reference Frantzides CT, Zografakis JG. Laparoscopic bypass with Roux-en-Y gastrojejunostomy. In: Frantzides CT, Carlson MA, editors. Atlas of minimally invasive surgery. Philadelphia: Saunders Elsevier; 2009. p. 53–66. Frantzides CT, Zografakis JG. Laparoscopic bypass with Roux-en-Y gastrojejunostomy. In: Frantzides CT, Carlson MA, editors. Atlas of minimally invasive surgery. Philadelphia: Saunders Elsevier; 2009. p. 53–66.
4.
go back to reference Blackstone RP. Roux-en-Y gastric bypass. In: Nguyen NT, DeMaria EJ, Ikrammudin S, Hutter MH, editors. The SAGES manual: a practical guide to bariatric surgery. Berlin: Springer; 2008. p. 87–100. Blackstone RP. Roux-en-Y gastric bypass. In: Nguyen NT, DeMaria EJ, Ikrammudin S, Hutter MH, editors. The SAGES manual: a practical guide to bariatric surgery. Berlin: Springer; 2008. p. 87–100.
5.
go back to reference Skandalakis LJ, Gray SW, Skandalakis JE. The history and surgical anatomy of the vagus nerve. Surg Gynecol Obstet. 1986;162(1):75–85.PubMed Skandalakis LJ, Gray SW, Skandalakis JE. The history and surgical anatomy of the vagus nerve. Surg Gynecol Obstet. 1986;162(1):75–85.PubMed
6.
go back to reference Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6(10):583–90.CrossRefPubMed Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6(10):583–90.CrossRefPubMed
7.
go back to reference Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal. Acta Medica Scandinavica. 1970;188(6):479–86.CrossRefPubMed Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal. Acta Medica Scandinavica. 1970;188(6):479–86.CrossRefPubMed
8.
go back to reference Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132(6):2253–71.CrossRefPubMed Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132(6):2253–71.CrossRefPubMed
9.
go back to reference Austrheim-Smith I, Brethauer SA, Rogula T, et al. Evolution of bariatric minimally invasive surgery. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63. Austrheim-Smith I, Brethauer SA, Rogula T, et al. Evolution of bariatric minimally invasive surgery. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63.
10.
go back to reference Mason EE, Printen KJ, Blommers TJ, et al. Gastric bypass in morbid obesity. Am J Clin Nutr. 1980;33(2 Suppl):395–405.PubMed Mason EE, Printen KJ, Blommers TJ, et al. Gastric bypass in morbid obesity. Am J Clin Nutr. 1980;33(2 Suppl):395–405.PubMed
12.
go back to reference Printen KJ, Scott D, Mason EE. Stomal ulcers after gastric bypass. Arch Surg. 1980;115(4):525–7.PubMed Printen KJ, Scott D, Mason EE. Stomal ulcers after gastric bypass. Arch Surg. 1980;115(4):525–7.PubMed
13.
go back to reference Griffen WO Jr. Gastric procedures for morbid obesity. In: Zuidema GD, Ritchie WP Jr, editors. Shackelford’s surgery of the alimentary tract, Vol II: stomach and duodenum, incisions. Philadelphia: W. B. Saunders Company; 1996. p. 190–202. Griffen WO Jr. Gastric procedures for morbid obesity. In: Zuidema GD, Ritchie WP Jr, editors. Shackelford’s surgery of the alimentary tract, Vol II: stomach and duodenum, incisions. Philadelphia: W. B. Saunders Company; 1996. p. 190–202.
14.
go back to reference Sugerman HJ, DeMaria EJ. Gastric surgery for morbid obesity. In: Nyhus LM, Baker RJ, Fischer JE, editors. Mastery of surgery. Boston: Little, Brown and Company; 1997. p. 982–91. Sugerman HJ, DeMaria EJ. Gastric surgery for morbid obesity. In: Nyhus LM, Baker RJ, Fischer JE, editors. Mastery of surgery. Boston: Little, Brown and Company; 1997. p. 982–91.
15.
go back to reference Pories WJ, Flickinger EG, Meelheim D, et al. The effectiveness of gastric bypass over gastric partition in morbid obesity: consequence of distal gastric and duodenal exclusion. Ann Surg. 1982;196(4):389–99.CrossRefPubMed Pories WJ, Flickinger EG, Meelheim D, et al. The effectiveness of gastric bypass over gastric partition in morbid obesity: consequence of distal gastric and duodenal exclusion. Ann Surg. 1982;196(4):389–99.CrossRefPubMed
16.
go back to reference Ikrammudin S. Technical pearls of laparoscopic bariatric surgery. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63.CrossRef Ikrammudin S. Technical pearls of laparoscopic bariatric surgery. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63.CrossRef
17.
go back to reference Thodiyil PA, Rogula T, Schauer PR. Linear stapled technique for gastrojejunal anastomosis. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63. Thodiyil PA, Rogula T, Schauer PR. Linear stapled technique for gastrojejunal anastomosis. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63.
18.
go back to reference Doherty C. Laparoscopic surgery for morbid obesity. In: Cameron JL, editor. Current surgical therapy. Mosby: St. Louis; 2001. p. 1467–76. Doherty C. Laparoscopic surgery for morbid obesity. In: Cameron JL, editor. Current surgical therapy. Mosby: St. Louis; 2001. p. 1467–76.
19.
go back to reference Wittgrove A, Rogula T. Circular stapler technique for gastroenterostomy. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63. Wittgrove A, Rogula T. Circular stapler technique for gastroenterostomy. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63.
20.
go back to reference Higa K. Laparoscopic Roux-en-Y gastric bypass: hand-sewn gastrojejunostomy technique. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63. Higa K. Laparoscopic Roux-en-Y gastric bypass: hand-sewn gastrojejunostomy technique. In: Schauer PR, Schirmer BD, Brethauer SA, editors. Minimally invasive bariatric surgery. New York: Springer Science + Business Media, LLC; 2007. p. 157–63.
21.
go back to reference Patterson EJ. Laparoscopic Roux-en-Y gastric bypass. In: Soper NJ, Swanstrom LL, Eubanks WS, editors. Mastery of endoscopic and laparoscopic surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 288–95. Patterson EJ. Laparoscopic Roux-en-Y gastric bypass. In: Soper NJ, Swanstrom LL, Eubanks WS, editors. Mastery of endoscopic and laparoscopic surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 288–95.
22.
go back to reference SAGES Guideline Committee. SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Endosc. 2008;22(10):2281–300.CrossRef SAGES Guideline Committee. SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Endosc. 2008;22(10):2281–300.CrossRef
23.
go back to reference Mallory GN, Macgregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6(6):474–8.CrossRefPubMed Mallory GN, Macgregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6(6):474–8.CrossRefPubMed
24.
go back to reference Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223–31.CrossRefPubMed Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223–31.CrossRefPubMed
25.
go back to reference Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205(6):613–24.CrossRefPubMed Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205(6):613–24.CrossRefPubMed
26.
go back to reference Cawley J, Sweeney MJ, Kurian M, et al. Predicting complications after bariatric surgery using obesity-related co-morbidities. Obes Surg. 2007;17(11):1451–6.CrossRefPubMed Cawley J, Sweeney MJ, Kurian M, et al. Predicting complications after bariatric surgery using obesity-related co-morbidities. Obes Surg. 2007;17(11):1451–6.CrossRefPubMed
27.
go back to reference Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353(3):249–54.CrossRefPubMed Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353(3):249–54.CrossRefPubMed
29.
go back to reference Kral JG. Effects of truncal vagotomy on body weight and hyperinsulinemia in morbid obesity. Am J Clin Nutr. 1980;33(2 Suppl):416–9.PubMed Kral JG. Effects of truncal vagotomy on body weight and hyperinsulinemia in morbid obesity. Am J Clin Nutr. 1980;33(2 Suppl):416–9.PubMed
30.
go back to reference Gray S, Skandalakis J, McClusky D, et al. Atlas of surgical anatomy for general surgeons. Baltimore: Williams & Wilkins; 1985. p. 120–5. Gray S, Skandalakis J, McClusky D, et al. Atlas of surgical anatomy for general surgeons. Baltimore: Williams & Wilkins; 1985. p. 120–5.
Metadata
Title
A Survey of Dumping Symptomatology after Gastric Bypass With or Without Lesser Omental Transection
Authors
Constantine T. Frantzides
Mark A. Carlson
Valerie K. Shostrom
Jacob Roberts
George Stavropoulos
George Ayiomamitis
Alexander Frantzides
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 2/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0124-0

Other articles of this Issue 2/2011

Obesity Surgery 2/2011 Go to the issue